The Value of Admission Avoidance: Cost-Consequence Analysis of One-Year Activity in a Consolidated Service

This is the authors' abstract. We don't add key points for this paper.

Background Many advantages of hospital at home (HaH), as a modality of acute care, have been highlighted, but controversies exist regarding the cost-benefit trade-offs. Objective To assess health outcomes and analytical costs of hospital avoidance (HaH-HA) in a consolidated service with over ten years of delivery of HaH in Barcelona (Spain). Methods A retrospective cost-consequence analysis of all first episodes of HaH-HA, directly admitted from the emergency room (ER) in 2017–2018, was carried out. HaH-HA was compared with a propensity-score-matched group of contemporary patients admitted to conventional hospitalization (Controls). Mortality, re-admissions, ER visits, and direct healthcare costs were evaluated. Registration ClinicalTrials.gov (26/04/2017; NCT03130283 ). Results HaH-HA and Controls (n=441 each) were comparable in terms of age (73 [SD16] vs 74 [16]), gender (male, 57% vs 59%), multimorbidity, healthcare expenditure during the previous year, case mix index of the acute episode, and main diagnosis at discharge. HaH-HA presented lower mortality during the episode (0 vs. 19 (4.3%); p < 0.001). At 30 days post-discharge, HaH-HA and Controls showed similar re-admission rates; however, ER visits were lower in HaH-HA than in Controls (28 (6.3%) vs 34 (8.1%); p = 0.044). Average costs per patient during the episode were lower in the HaH-HA group (€ 1,078) than in Controls (€ 2,171). Likewise, healthcare costs within the 30 days post-discharge were also lower in HaH-Ha than in Controls ( p < 0.001). Conclusions The study showed higher performance and cost reductions of HaH-HA in a real-world setting. The identification of sources of savings facilitates scaling of hospital avoidance. Funding This article was funded by JADECARE project- HP-JA-2019 - Grant Agreement n º 951442 (2020-2023), a European Union’s Health Program 2014-2020. KEY POINTS Hospital at home, modality hospital avoidance, shows high potential for value generation in real-world settings by improving health outcomes and generating cost-savings. Positive outcomes of hospital avoidance seem associated to adequate management change and digital support.